ECE2021 Audio Eposter Presentations Pituitary and Neuroendocrinology (113 abstracts)
Pulmonary thromboembolism-caused acute severe euvolemic hyponatremia complicated by COVID-19 infection: A case report
Bojan Joksimovic 1 , Milica Radovic 2 , Bojan Mitrovic 3 , Sasa Pancevacki 2 , Vladimir Samardzic 1 , Milena Lackovic 1 , Milan Obradovic 4 , Esma R. Isenovic 4 , Zoran Gluvic 3 , Sandra Pekic Djurdjevic 5 & Milan Petakov 5
1Zemun Clinical Hospital, Department of Endocrinology and Diabetes, Zemun, Serbia; 2Zemun Clinical Hospital, Department of Medicine ITU, Zemun, Serbia; 3Zemun Clinical Hospital, Department of Endocrinology, Diabetes and Medicine ITU, Zemun, Serbia; 4’VINČA’ Institute of Nuclear Sciences- National Institute of the Republic of Serbia, Laboratory for radiobiology and molecular genetics, Belgrade, Serbia; 5Clinic for Endocrinology, Diabetes and Diseases of Metabolism, Clinical Center of Serbia, Belgrade, Serbia, Belgrade, Serbia
Introduction
Hyponatremia is frequently encountered in clinical practice. Euvolemic hyponatremia (Syndrome of Inadequate Antidiuresis, SIAD) represents diagnostic and management challenge regarding etiology unraveling, its gradual acute substitution, and later causal treatment.
Case report
A 68-year-old woman was admitted to the Emergency unit with acute psychosis. On examination, there were no focal neurological signs. On admission, she had severe euvolemic hyponatremia (repeated serum sodium level of 101 mmol/l), while other laboratory parameters were within normal range, except for mild normocytic anemia. Further investigations confirmed the diagnosis of segmental pulmonary thromboembolism as a possible cause of SIAD, after other causes were excluded (malignancy, drugs, CNS diseases…). Hyponatremia was corrected carefully with hypertonic saline infusion and fluid intake restriction. The patient recovered from psychosis immediately with a gradual increase in serum sodium levels and its normalization. She was treated with low molecular weight heparin followed by oral anticoagulant therapy. After three weeks of treatment, the patient’s medical history was complicated by asymptomatic SARS CoV-2 infection, and the patient was transferred to a COVID treatment determined hospital. Even though she has belonged to the high-risk group regarding the clinical outcome of COVID-19, her chest X-ray was normal. During hospitalization, her sodium level remained in the reference range (138–142 mmol/l) on unrestricted fluid intake.
Conclusion
This case should alert a clinician regarding the possibility of reversible psychosis in a patient presenting with acute severe hyponatremia caused by pulmonary thromboembolism. Her condition was further complicated by a COVID-19 infection, from which she recovered with no additional complications. Even in the cases with life-threatening hyponatremia (101 mmol/l), complete recovery of patients could be obtained by simultaneous careful correction of hyponatremia and management of its possible cause.
Keywords: hyponatremia, hypertonic saline, pulmonary thromboembolism
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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